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These 3 Conditions Cause Three-Fourths of the Most Harmful Diagnostic Errors

A misdiagnosis or delayed diagnosis is behind one-third of the malpractice cases that end in permanent disability or death, according to a study from the Johns Hopkins University School of Medicine.

What Did the Study Find?

The study, published in Diagnosis, notes that each year, some 40,000 to 80,000 deaths in U.S. hospitals are linked to a misdiagnosis, and that around 12 million Americans are subjected to a diagnostic error in a primary care setting. Some 33 percent of these either are fatal or result in serious injury.

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The analysis found that of the most harmful diagnostic errors, 74.1 percent were attributable to just three categories of conditions: cancer (37.8 percent), vascular events (22.8 percent), and infection (13.5 percent). These severe cases resulted in $1.8 billion in malpractice payouts over 10 years. 

The researchers defined “diagnostic errors” as “the failure to (a) establish an accurate and timely explanation of the patient’s health problem(s) or (b) communicate that explanation to the patient” per the National Academy of Medicine. They defined “misdiagnosis-related harm” as “harm resulting from the delay or failure to treat a condition actually present, when the working diagnosis was wrong or unknown [delayed or missed diagnosis (false negative)], or from treatment provided for a condition not actually present [wrong diagnosis (false positive)].”

The cross-sectional analysis, which focused on a large medical malpractice claims database, was the first of a three-phase project to gauge the U.S. burden of serious misdiagnosis-related harms. 

“Serious morbidity is about as common as mortality, so diagnostic safety and quality measures must take this into account,” noted the authors in the article. “Mortality more often reflects missed non-neurologic vascular events/infections, while severe morbidity more often reflects missed neurologic vascular events/infections or cancer delay.” 

The analysis confirms that of medical errors, delayed or inaccurate diagnosis continues to be the most common, most catastrophic, and most costly. It also provides additional context for a 2015 National Academy of Medicine report that said diagnostic errors in U.S. hospitals resulted in close to 80,000 deaths.

What Does the Study Mean for Healthcare Providers?

“It is not just inconvenient to have a wrong or delayed diagnosis. For many patients, misdiagnosis causes severe harm and expense, and in the worst cases, death,” said David Newman-Toker, MD, PhD, lead author of the research and director of the Johns Hopkins Armstrong Institute for Patient Safety and Quality’s Center for Diagnostic Excellence, in a statement.

“If we’re going to reduce serious harms from medical errors, major strides must be made to improve diagnostic accuracy and timeliness,” Dr. Newman-Toker continued. “This study shows us where to focus to start making a difference for patients. It tells us that tackling diagnosis in these three specific disease areas could have a major impact on reducing misdiagnosis-related harms.”

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Added Paul L. Epner, CEO and co-founder of the Society to Improve Diagnosis in Medicine: “This work showcases that myriad factors contribute to missed and delayed diagnosis and highlights the need for further collaboration across the healthcare system to significantly improve diagnosis and ensure the best possible outcomes for patients.”

The authors note that future research should try to more succinctly clarify the relationship between harms in malpractice claims and harms in real-world clinical practice, especially with cancer, which they point out appears to be over-represented in claims.

Serious misdiagnosis-related harms in malpractice claims: The “Big Three” – vascular events, infections, and cancers, Diagnosis.
Analysis: One in Three Malpractice Cases with Serious Patient Harms Are Due to Misdiagnosis, Society to Improve Diagnosis in Medicine.

Last updated on 10/9/19.

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